Tuberculosis associated thrombocytopenic purpura: effectiveness of antituberculous therapy

Association of immune thrombocytopenic purpura and tuberculosis is a rare condition. In 5 patients presenting with this association, anti-tuberculous therapy was effective on both tuberculosis and thrombocytopenia suggesting a causal relationship between tuberculosis and immune thrombocytopenic purpur

Migraciones interregionales y ciclos económicos en España (1988- 2001)

Este artículo analiza la relación entre coyuntura económica y dinámica migratoria interregional en España en el período 1988-2001 a partir de la Estadística de Variaciones Residenciales (EVR). El estudio establece un nexo entre las fases del ciclo económico y la dinámica migratoria interregional: los jóvenes presentan una mayor movilidad en las fases expansivas de la economía y las CC. AA. españolas juegan papeles muy distintos en cada una de las fases del ciclo económico. Las regiones de tradición inmigratoria tienen saldos positivos entre los jóvenes y negativos entre la población de más de 55 años. Las regiones que habían sido emigratorias en los años sesenta y setenta experimentan el proceso inverso: emigración neta de jóvenes y retornos de los emigrantes de otros períodos. La migración interregional de jóvenes es afectada significativamente por las fases del ciclo económico mientras que la evolución del grupo de más de 55 años es independiente de la coyuntura económica

High-resolution CT phenotypes in pulmonary sarcoidosis: a multinational Delphi consensus study

One view of sarcoidosis is that the term covers many different diseases. However, no classification framework exists for the future exploration of pathogenetic pathways, genetic or trigger predilections, patterns of lung function impairment, or treatment separations, or for the development of diagnostic algorithms or relevant outcome measures. We aimed to establish agreement on high-resolution CT (HRCT) phenotypic separations in sarcoidosis to anchor future CT research through a multinational two-round Delphi consensus process. Delphi participants included members of the Fleischner Society and the World Association of Sarcoidosis and other Granulomatous Disorders, as well as members' nominees. 146 individuals (98 chest physicians, 48 thoracic radiologists) from 28 countries took part, 144 of whom completed both Delphi rounds. After rating of 35 Delphi statements on a five-point Likert scale, consensus was achieved for 22 (63%) statements. There was 97% agreement on the existence of distinct HRCT phenotypes, with seven HRCT phenotypes that were categorised by participants as non-fibrotic or likely to be fibrotic. The international consensus reached in this Delphi exercise justifies the formulation of a CT classification as a basis for the possible definition of separate diseases. Further refinement of phenotypes with rapidly achievable CT studies is now needed to underpin the development of a formal classification of sarcoidosis

A Novel, Minimally Invasive Method to Retrieve Failed Dental Implants in Elderly Patients

This practice-based study presents the clinical outcomes of a minimally invasive method for retrieving failed dental implants from elderly patients. Traditional removal methods for failed dental implants include trephination and other invasive procedures. That can be a special concern for the elderly, since aging exacerbates oral surgery-related morbidity and anxiety. This retrospective cohort study gathers data from 150 patients seen in a private clinic. Their implants (n = 199) failed due to biological, mechanical, or iatrogenic causes, and were removed as part of their treatment plan. Collected data included: (1) implant location (maxilla/mandible, anterior/posterior region), (2) reasons for implant retrieval, (3) connection type, (4) removal torque, and (5) operatory procedure—flapless and using a counter-torque removal kit, whenever possible. Flapless/minimally invasive retrieval was successful for 193 implants (97%). The remaining six implants demanded trephination (open-flap). The most common reasons for implant retrieval (81%) involved biological aspects, whereas iatrogenic (12%) and biomechanical (7%) reasons were less common. The surgical technique used was not associated to connection types or removal torque. Authors conclude that a counter-torque ratchet system is a minimally invasive technique with a high success rate in retrieving implants from elderly patients. Present findings support its use as a first-line approach for implant retrieval in that population

Biomechanical Behavior of Narrow Dental Implants Made with Aluminum- and Vanadium-Free Alloys: A Finite Element Analysis

Titanium (Ti) alloys used for narrow dental implants usually contain aluminum (Al) and vanadium (V) for improved resistance. However, those elements are linked to possible cytotoxic effects. Thus, this study evaluated the biomechanical behavior of narrow dental implants made with Al- and V-free Ti alloys by the finite element method. A virtual model of a partially edentulous maxilla received single implants (diameter: 2.7 and 2.9 mm; length: 10 mm) at the upper lateral incisor area, with respective abutments and porcelain-fused-to-metal crowns. Simulations were performed for each implant diameter and the following eight alloys (and elastic moduli): (1) Ti–6Al–4V (control; 110 GPa), (2) Ti–35Nb–5Sn–6Mo–3Zr (85 GPa), (3) Ti–13Nb–13Zr (77 GPa), (4) Ti–15Zr (113 GPa), (5) Ti–8Fe–5Ta (120 GPa), (6) Ti–26.88Fe–4Ta (175 GPa), (7) TNTZ–2Fe–0.4O (107 GPa), and (8) TNTZ–2Fe–0.7O (109 GPa). The implants received a labially directed total static load of 100 N at a 45° angle relative to their long axis. Parameters for analysis included the maximum and minimum principal stresses for bone, and von Mises equivalent stress for implants and abutments. Ti–26.88Fe–4Ta reaches the lowest maximum (57 MPa) and minimum (125 MPa) principal stress values, whereas Ti–35Nb–5Sn–6Mo–3Zr (183 MPa) and Ti–13Nb–13Zr (191 MPa) models result in the highest principal stresses (the 2.7 mm model surpasses the threshold for bone overload). Implant diameters affect von Mises stresses more than the constituent alloys. It can be concluded that the narrow implants made of the Ti–26.88Fe–4Ta alloy have the most favorable biomechanical behavior, mostly by mitigating stress on peri-implant bone

Management of suspected monogenic lung fibrosis in a specialised centre

At least 10% of patients with interstitial lung disease present monogenic lung fibrosis suspected on familial aggregation of pulmonary fibrosis, specific syndromes or early age of diagnosis. Approximately 25% of families have an identified mutation in genes mostly involved in telomere homeostasis, and more rarely in surfactant homeostasis. Beyond pathophysiological knowledge, detection of these mutations has practical consequence for patients. For instance, mutations involved in telomere homeostasis are associated with haematological complications after lung transplantation and may require adapted immunosuppression. Moreover, relatives may benefit from a clinical and genetic evaluation that should be specifically managed. The field of genetics of pulmonary fibrosis has made great progress in the last 10 years, raising specific problems that should be addressed by a specialised team